In its SDOH Playbook, “US Playbook to Address the Social Determinants of Health,” the White House explained that supporting flexible funding to address social needs, such as those offered through health-related social needs (HRSN) reimbursement programs, improves health outcomes: “Increasing funding flexibility and offering technical assistance that empowers organizations to utilize funding from a variety of sources will better equip them to address unmet social needs.”
The success of these reimbursement programs requires the existence of exchange and data standards that serve the interests of all stakeholders. Payers and community-based organization (CBOs) currently experience complexities and pain points that have presented challenges and made it difficult to meet the HRSN reimbursement programs’ full potential exist as these benefits roll out today.
As momentum has grown among states and payers for the reallocation of healthcare funds to address HRSNs, Gravity Project decided to undertake a discovery effort to understand and define the existing landscape for CBO reimbursement and identify the components of the CBO reimbursement process and where national standards play a role.
"Unite Us is proud to work with the Gravity Project. Together, we are making it easier for community-based organizations to participate in Medicaid reimbursement programs, expanding the availability of these benefits to more individuals seeking care,” Emily Anders, director of payments strategy for Unite Us, said. The results of its discovery effort are available online in its report, Payments Data & Exchange Standards: Gravity Project Discovery Findings.
“This report is an exciting step toward a more unified, efficient reimbursement framework for Health-Related Social Needs (HRSN) services. We aim to build a foundation that will ease administrative burdens on CBOs. This discovery report lays the groundwork for scalable, sustainable standards that bridge healthcare and social care.” Anders notes.
The report will be discussed at a Listening Session held during Gravity Project's Tech public call on November 13, 2024 at 1 p.m. ET. In addition to Anders, presenters include: Sarah DeSilvey, DNP, FNP-C, Gravity terminology director; Alana Kalinowski, director of interoperability and collective impact, 2-1-1 San Diego/Community Information Exchange (CIE); Corey Smith, technical director, Gravity Project, and vice president, informatics and digital products, American Medical Association; and Corey Spears, consultant, Lantana Consulting Group.
All Gravity Project member organizations were invited to participate in the Discovery Committee, which included leaders from the healthcare, social services and technology sectors. In order to provide ample representation for and capture the perspective of CBOs in states with existing CBO reimbursement programs, additional CBOs representing such states were invited to participate. Over six weeks, the Discovery Committee discussed funding types, activities, actors, existing resources, and gaps in the CBO reimbursement process.
The Listening Session features a discussion of the effort and goals of the discovery process and an overview of the report, covering its background, goals, process, findings and opportunities, including initially focusing on standardizing the reimbursement framework for HRSN services under Medicaid, with subsequent extension to other funding streams. Leaders representing applicable Gravity terminology and technology work will provide context and a springboard for participant discussion.
During the discussion, the Gravity Team is looking to hear about your experiences and awareness of these challenges and solutions, and if there are any areas you want to learn more about to improve your processes and care delivery.
The discussion will enable the Gravity team to listen for and identify further requirements, potential educational topics and opportunities for standards advancements.
Join the Listening Session on November 13!
To join the Listening Session and learn more, visit https://confluence.hl7.org/pages/viewpage.action?pageId=91998331